If a stone is lodged in the ureter, a narrow instrument called a ureteroscope can be passed up through the bladder and into the ureter. The stone is captured and removed, or broken up using a holmium laser. For smaller stones in the kidney that have not responded to ESWL a small flexible ureteroscope can be used, and a laser passed up this to break the stone into small pieces. These procedures are usually done under a general anaesthetic, and often can be done as a daycase.
Laser fibre (blue) used to fragment the stone under direct vision.